CLEVELAND, Ohio - When you walk into any of the MetroHealth System's locations throughout Cuyahoga County, you're likely to see someone wearing a pronoun of choice button on their lapel.

From schedulers to nurses to doctors, MetroHealth staff are pinning pronoun buttons on their scrubs and lab coats as part of the system's new pronoun project. Designed to open up conversations about identity, the buttons share how the wearer wants to be addressed: she/hers, he/his, ze/zir, they/their. Patients are invited to wear stickers identifying their own pronouns, too.

"The gender identification is key because everybody wants to be known as somebody," said Todd Mahaffey of Warren, who identifies as a gay man. "I think that's a huge plus for our community to know that you can go somewhere where it's comfortable."

The local pronoun project, which was inspired by a similar effort at Callen-Lorde Community Health Center in New York, is just part of a larger move by two of the area's hospital systems to advance LGBT healthcare in Cleveland. University Hospitals treats LGBT patients, but doesn't have a specific program.

In the past year, both MetroHealth and the Cleveland Clinic have started expanding LGBT care to more locations. MetroHealth's PRIDE Clinic celebrates its 10th anniversary this year and plans to expand its offerings. The program, which began as a grassroots effort by Dr. Henry Ng (he/him/his), the director of internal medicine and pediatrics at MetroHealth, now serves thousands of patients each year.

Likewise, the Cleveland Clinic last June introduced integrated LGBT centers at its Lakewood and Chagrin Falls family health centers.

"I think the bottom line is: It's important to have this type of care at all health systems so patients don't fall through the cracks," said Ng.

Before the Cleveland Clinic started integrating LGBT care into its services, there was no way for LGBT patients to determine which providers would be good matches. Instead, they had to pick a name out of a hat. Now, the Clinic provides a list of LGBT-trained doctors and, like MetroHealth, has a computer system that can track sexual orientation and gender identity.

"One of the things we wanted to do was provide certain guarantees to patients who come to see us that the staff would be educated on language that would be culturally competent," said Dr. James Hekman, medical director of the Lakewood Family Health Center.

That involves asking sensitive, respectful questions and not making assumptions, he said.

Prior to becoming Hekman's patient a few years ago, Mahaffey had to see both a primary care physician and an infectious disease doctor. Now, he only needs to see one and in a setting with a physician with whom he feels comfortable.

"There's, I think, a very important piece in having both clinical competency and a cultural competency," said MetroHealth's Ng.

The Cleveland Clinic decided to put a focus on LGBT care based on what they saw as political and cultural changes in the U.S., as well as an ever-growing body of research on the health disparities experienced by the LGBT community. Nationwide, 4.1 percent of Americans identify as LGBT, compared to 3.5 percent in 2012, according to a Gallup poll.

"With the approval of same-sex marriage and the prevailing cultural winds, the time felt right to invest in these issues," Hekman said.

With its centers now off the ground, the Clinic is developing an LGBT youth program, investing in its transgender surgical services and considering expanding its LGBT center model to one of its locations in Florida.

Despite being called LGBT centers, the Clinic's LGBT services are integrated into each location, meaning LGBT patients are seen alongside straight patients.

"They're not siloed and meant to feel separate. We think it allows people to come in as they are," Hekman said.

With its expansion, MetroHealth is moving in the same direction. Known as the PRIDE Network, MetroHealth is adding LGBT health services to other locations, instead of only offering services at the PRIDE Clinic, which is housed in McCafferty Health Center, 4242 Lorain Ave.

For years, patients could only access the PRIDE Clinic for a few hours on Wednesday evenings, making it a challenge to see everyone and to schedule follow-up appointments, Ng said. But now, patients can see LGBT-affirming physicians at the main campus, McCafferty, Brecksville and Middleburg Heights locations and, starting in August, in Rocky River.

"For me, it's been an exciting ride," said Ng. "When we started the clinic, it was a dedicated brick and mortar one-night-a-week session. It kind of evolved out of that."